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Development of the End-of-Life Care Nursing Attitude Scale for Japanese Geriatrics

Okumura-Hiroshige, Akemi, MSN, RN, PHN; Fukahori, Hiroki, PhD, RN, PHN; Yoshioka, Sachiko, MSN, CNS; Kuwata, Miyoko, MSN, CNS; Nishiyama, Midori, MSN, CNS; Takamichi, Kaori, MSN, CNS

Journal of Hospice & Palliative Nursing: June 2018 - Volume 20 - Issue 3 - p 272–278
doi: 10.1097/NJH.0000000000000442
Feature Articles

This study aimed to develop an end-of-life (EOL) care nursing attitude scale for Japanese geriatric nurses (ELNAS-JG). The items of the ELNAS-JG were developed to cover important topics related to EOL care (eg, motivation for providing EOL care, pain and symptom management, and decision-making support care for older adults). Participants were 1663 nurses employed in 32 institutions across Japan. Of these, 1298 participants were analyzed. An exploratory factor analysis of the 26 scale items revealed a 3-factor solution describing the concepts of responsibility, willingness, and confidence: responsibility and willingness were captured in factor 1 (16 items), and confidence was split into factor 2 (6 items) and factor 3 (4 items) to capture individual and collaborative behaviors. The overall Cronbach α coefficient for the 26 items was 0.95, and the intraclass correlation coefficient was 0.83. Overall, the ELNAS-JG was confirmed to have good internal consistency, test-retest reliability, content validity, known-groups validity, and construct validity. It can comprehensively measure nurses' attitudes toward EOL care for older adults in any EOL setting. Furthermore, this scale can be used to evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

Akemi Okumura-Hiroshige, MSN, RN, PHN, is PhD Candidate, Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan.

Hiroki Fukahori, PhD, RN, PHN, is Associate Professor, Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan.

Sachiko Yoshioka, MSN, CNS, is Associate Director of Nursing, Matsue City Hospital, Shimane, Japan.

Miyoko Kuwata, MSN, CNS, is Director, Division of Nursing Care Development, Oume Keiyu Hospital, Tokyo, Japan.

Midori Nishiyama, MSN, CNS, is Director, Division of Care Development, Arima Onsen Hospital, Hyogo, Japan.

Kaori Takamichi, MSN, CNS, Division of Practical Nursing Education for Geriatric, National Center for Geriatrics and Gerontology, Aichi, Japan.

Address correspondence to Akemi Okumura-Hiroshige, MSN, RN, PHN, 1-5-45 Yushima Bunkyo-ku, Tokyo 133-8510, Japan (

This study was supported by a research grant on hospice palliative care from the Sasakawa Memorial Health Foundation (no. 2014A-14).

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.